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Abstract: SA-PO649

Creatinine Clearance Predicts Longitudinal Phosphate Levels Irrespective of Achieved Urea Kt/V: A Peritoneal Dialysis-MONDO Analysis

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Diaz Bessone, Maria Ines, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • De la Torre Quiroga, Andres E., Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico
  • Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States
  • Garcia-Garcia, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico
  • Peters, Vincent, Tilburg University, Tilburg, Netherlands
  • Konings, Constantijn, Catharina Ziekenhuis, Eindhoven, North Brabant, Netherlands
  • Guinsburg, Adrian M., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Moraes, Thyago Proença de, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

Serum phosphate (PO4) is associated with worse outcomes among kidney failure patients, and its dialysis clearance is not well predicted by small solute kinetics. Guidelines in peritoneal dialysis (PD) recommend using urea Kt/V over creatinine clearance (CrCl) to monitor dialysis adequacy. We hypothesize that this recommendation may lead to suboptimal PO4 control. We designed this study to evaluate if CrCl predicts longitudinal PO4 irrespective of achieved Kt/V.

Methods

We performed a longitudinal analysis of multiple cohorts of incident PD patients – Fresenius Medical Care Latin America (FMC-LATAM), Renal Research Institute (RRI), Mount Sinai Hospital, Hospital Civil Guadalajara, and the BRAZPD cohort. The exposures were first available Kt/V and CrCl after 90 days of PD initiation. The outcome was longitudinal PO4. Results were pooled using a random-effects metanalysis. The primary estimate was the linear coefficient from linear mixed regression models with random effects. Models were then compared by log-likelihood ratios (LLR) to assess the information added by CrCl on models with Kt/V.

Results

16.796 patients were included RRI (n=653), Sinai (n=131), BRAZPD (n=171), LATAM (n=15631), and Guadalajara (n=210). Mean ages ranged from 45 (Guadalajara) to 58 years (Sinai). In most datasets, Kt/V and CrCl were associated with longitudinal PO4 despite adjusting for sex, age, and PO4 binder use. The pooled estimates, despite being heterogeneous, confirmed the results (Figure). For all datasets, including CrCl on models adjusted with Kt/V improved information (LLR tests p< 0.05 for all datasets).

Conclusion

Among incident PD patients, CrCl predicts longitudinal PO4 irrespective of achieved urea Kt/V. Our results suggest that CrCl may be an important measurement in clinical practice to monitor PO4 clearance in PD patients.